Indonesian Children In Violent Communities Helped By School-Based Mental Health Program

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Main Category: Psychology / Psychiatry
Also Included In: Pediatrics / Children's Health
Article Date: 13 Aug 2008 - 8:00 PDT

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According to new research published in JAMA, children in Indonesian communities affected by political violence who received a school-based intervention had reductions in post-traumatic stress symptoms and were more likely to maintain hope. The international team of researchers also found, however, that the intervention failed to reduce traumatic stress-related symptoms, depressive symptoms, anxiety symptoms, or functional impairment.

"Mental health and psychosocial interventions for children and adolescents globally have received little research attention, even though mental health problems are one of the most significant contributors to the global burden of disease," write Wietse A. Tol, M.A., (HealthNet TPO, Vrije Universiteit Medical Center, Amsterdam, the Netherlands) and colleagues. "Little is known about the efficacy of mental health interventions for children exposed to armed conflicts in low- and middle-income settings. Childhood mental health problems are difficult to address in situations of ongoing poverty and political instability."

To assess the effectiveness of a school-based intervention on children in a low-income setting who are also exposed to conflict, Tol and colleagues conducted a cluster randomized trial in the politically violent Poso, Indonesia. The researchers randomly assigned 14 community schools to either the treatment or wait-list (control) groups, resulting in a sample of 495 children who were about 9.9 years of age. All children underwent screenings for exposure to violent events, post-traumatic stress disorder (PTSD), and anxiety symptoms. The intervention - occurring in school with 15 sessions over 5 weeks - consisted of trauma-processing activities, cooperative play, and creative-expressive elements. Locally trained paraprofessionals implemented the intervention.

The analysis revealed that the intervention moderately reduced PTSD symptoms and function impairment for girls and helped both boys and girls retain hope. The researchers add: "No changes were found on the other outcome variables; traumatic idioms, depressive, anxiety symptoms, and functioning (the latter for boys)...We hypothesize that these results may show that psychosocial interventions alone are unable to reverse the challenges to psychosocial well-being presented by chronic poverty and political instability."

Though the treatment resulted in an overall improvement of PTSD symptoms and hope maintenance in the treatment group compared to the control group, the effects were moderated by gender: girls seemed to benefit from the intervention more than boys. No significant effects were noted for age.

"In short, a school-based psychosocial intervention was able to moderately reduce PTSD symptoms, retain hope, and improve functioning for girls, and retain hope for boys affected by communal violence in a low-income context," conclude Tol and colleagues. "Further adaptations and research to address the full range of post-traumatic outcomes and functioning are necessary."

School-Based Mental Health Intervention for Children Affected by Political Violence in Indonesia: A Cluster Randomized Trial
Wietse A. Tol, MA; Ivan H. Komproe, PhD; Dessy Susanty, MPsych; Mark J. D. Jordans, MA; Robert D. Macy, PhD; Joop T. V. M. De Jong, MD, PhD
JAMA(2008). 300[6]: pp. 655-662.
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Written by: Peter M Crosta
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